Changes in the Professional Lives of Cardiologists Over 2 Decades

Lewis SJ, Mehta LS, Douglas PS, et al.
Changes in the Professional Lives of Cardiologists Over 2 Decades. J Am Coll Cardiol 2016;Dec 21:[Epub ahead of print].

The following are key points to remember from this article, which summarizes results of a survey about changes in the professional lives of cardiologists over 2 decades:

  1. Cardiovascular physicians and the practice of cardiovascular medicine have experienced unprecedented changes in both the explosion of scientific evidence and changes in reimbursement models over the past 20 years. The American College of Cardiology (ACC), led by the Leadership Council of the Women in Cardiology (WIC) Section, conducted the third decennial Professional Life Survey to define current workforce demographics and career choices, define levels of cardiologists’ career satisfaction, identify family and professional barriers to success, and pinpoint areas of concern for the College to guide development of initiatives with high member value.
  2. The first survey in 1996 identified opportunities to improve the professional lives of cardiologists. Amongst the most important were practice management, job negotiations, and leadership training for both men and women. Specific sex differences and concerns included occupational radiation exposure, discrimination, family concerns such as barriers to childbearing and childcare needs, lack of advancement, disparity in compensation, and stresses of the profession. The second survey in 2006 found high levels of career satisfaction for men and women in cardiology and increasing positive effects of mentors, but ongoing areas of differences between men and women in other areas.
  3. The concerns were addressed by the WIC including Leadership Workshops, visiting professors, virtual mentoring, and incorporation of fellows in training (FIT) into all ACC committees and specific programming at ACC and state chapter networks. A particular focus of the 3rd survey was to determine whether ACC efforts and ongoing societal changes are associated with mitigation of the observed differences between men and women in cardiology 20 years after the first survey.
  4. The 2015 survey was sent to 10,798 individuals, including 8,821 (2,796 women and 6,025 men) cardiologist members, and 1,977 FIT. A total of 2,313 physicians completed the survey, including 964 women (42%) and 1,349 men (58%); of these, 94 women and 202 men were FITs, representing 13% of the total number of respondents. The overall response rate to the survey was 21%, which was lower than the response rates of 31% in 2006 and 49% in 1996. The current survey response rate was 30% for women, 18% for men, and 15% for FITs, with higher response rates for women, as in 2006 (42% for women and 23% for men) and 1996 (54% for women and 46% for men).
  5. Of the responders, the distribution of men and women was similar, with a greater percent 60 years of age or older than in the other surveys; women were more likely to be black and men more likely to be Hispanic. A lower percentage of women were practicing adult cardiology (80% vs. 85%, p ≤ 0.01), a higher percentage of women were self-identified as pediatric cardiologists, women were more likely to practice part-time (10% vs. 4%, p ≤ 0.001), and there were equal percentages of women and men not currently in practice (10% for both).
  6. Research and teaching occupied a higher percentage of time for women (14% vs. 10%, p ≤ 0.05), whereas similar amounts of time were spent in administrative activities. Women were more likely to work in a medical school/university practice (43% vs. 34%, p ≤ 0.001), and less likely to work in a hospital-owned (33% vs. 37%, p ≤ 0.01) or physician-owned (17% vs. 23%, p ≤ 0.001) setting. There was a marked decrease in men and women working in private practice over the 20 years (average 60% in 1996 and 30% in 2015), which was not due to an increase in university/medical school settings. Women were more likely to practice general clinical cardiology (48% vs. 39%, p ≤ 0.001) or echocardiography (10% vs. 3%, p ≤ 0.001), while men were more likely to practice interventional cardiology (23% vs. 8%, p ≤ 0.001) or electrophysiology (10% vs. 6%, p ≤ 0.01).
  7. Cardiologists were satisfied with their work lives and financial compensation, but women were less satisfied with family life. The proportion of women who were moderately or very satisfied with their careers rose from 80% to 90% between 1996 and 2006, and remained similar. Women were significantly less likely to report achieving a higher level of advancement, and more likely to report lower or much lower advancement than male colleagues. The proportion of men who indicated that their level of advancement was higher or much higher than contemporaries declined for each decade, from 52% in 1996 to 45% in 2006, and to 39% in 2015 (p ≤ 0.05); however, men’s career satisfaction did not change. Pay differential between female and male academic cardiologists is almost exactly the same as that seen in private practice ($33,749 in a fully-adjusted model for academic cardiologists vs. $37,717).
  8. The perceived importance of job description, benefits, and salary were highest followed by vacation time, support staff, and time to promotion/partnership, which were similar for women and men. Each of these items has risen compared with prior surveys. Salary, benefits, vacation time, and work hours were of similar import with women and men with a subsequent job, whereas promotion (70% vs. 64%, p ≤ 0.01), academic rank (57% vs. 43%, p ≤ 0.001), seniority (64% vs. 50%, p ≤ 0.001), and administrative duties (68% vs. 60%, p ≤ 0.001) were more important for women than for men.
  9. Similar numbers of men and women had mentors during subspecialty training, but women were significantly more likely to have a woman and a pediatric cardiologist mentor. Respondents noted an increase over time in mentoring related to noncareer role models and career planning and decision making. Career encouragement declined for both sexes. Men remained just as likely in 2015 to report that their mentors served as negative role models in areas such as family and lifestyle (noncareer) as in 1996 and 2006, but for women, mentors became significantly less likely to exert a negative influence as family and lifestyle role models in the present survey.
  10. As compared with the other two surveys, fewer women planned conception and pregnancy for times in their career during which they were not exposed to radiation, and there was no significant change in the percentage of women who made modifications to their work schedules in order to reduce radiation exposure. About one-quarter of women chose career or training paths with minimal radiation exposure and one-third performed procedures using radiation while pregnant, neither of which changed from 10 and 20 years ago.
  11. A large majority of women reported experiencing some form of discrimination, at a rate almost 3 times as frequently as men, and the types of discrimination experienced were strikingly different. Sex and parenting discrimination was significantly more likely to have been experienced by women compared with men, whereas men were significantly more likely to have experienced racial and religious discrimination. There was no change in rate of discrimination for men, but there was a significant decline in the number of women reporting discrimination overall between 1996 and 2015 (71% vs. 65%, respectively, p ≤ 0.05). Women in practice longer were significantly more likely to say that they had experienced discrimination (72% of women in practice ≥11 years vs. 56% of FITs and women in practice <10 years, p ≤ 0.001 for comparison).
  12. In 2015, significantly more men reported being married compared with women (89% vs. 75%, p ≤ 0.001), were more likely to have children (87% vs. 72%, p ≤ 0.001), and, for most men, spouses provided all childcare (57% vs. 13%, p ≤ 0.001). Women with children at home were significantly more likely than men to report they had paid full-time care, utilized a daycare center, or had paid part-time care. Women were significantly more likely to interrupt their training than men, and these interruptions were typically for childbirth. Family responsibilities affected women to a greater degree than men, as 37% of women said family responsibilities had a negative impact on career advancement (37% vs. 20%, p ≤ 0.001) as well as ability to do professional work and travel for professional advancement. Over the 20 years, an increasing number of women reported having children and a growing trend for men to indicate that family responsibilities hindered their work and negatively influenced their career advancement.
  13. The 1996 ACC Professional Life Survey identified a lack of ethnic and sex diversity, an aging workforce, and discrimination as critical issues for cardiology, all of which remain relevant in 2016. According to ACC demographic data, 34% of women cardiologists were >50 years of age in 2006 versus 50% in 2016, and 56% of men in 2006 versus 74% in 2016 were >50 years of age. In parallel with substantial changes in society and medicine, the survey data illustrate changes in the personal and professional lives of cardiologists over the past 2 decades. The workforce is aging, practice settings have changed, and men are increasingly balancing career and family. However, in many areas, little has changed. Women continue to be less likely to marry and to have children, more likely to require paid or unpaid help with childcare, and more frequently experience discrimination. For both sexes, career satisfaction remains high.

Comment: The significant decrease in percentage of compliance with the survey may have influenced the validity of comparing the decades. Importantly, among the variables responsible for the decreasing career advancement for both women and men may be related to the number of cardiologists in academic hospital/university practice, the aging of the cardiologists, and the increasing years spent in leadership positions.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound

Keywords: Cardiology, Career Choice, Echocardiography, Electrophysiology, Health Manpower, Job Description, Job Satisfaction, Leadership, Life Style, Marriage, Mentors, Personal Satisfaction, Professional Practice, Radiation, Salaries and Fringe Benefits, Sex Characteristics

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